Headache and Migraine Care

Headaches and migraines are more than an inconvenience. They can affect every part of your life – work, school, family time and the activities you enjoy most. Whether you're experiencing occasional migraines, frequent headaches or complex headache disorders, ChristianaCare's headache specialists can help you understand your symptoms and create a personalized plan to help you feel better.

Conditions we treat include but are not limited to:

Headaches aren't all the same. Different types of headaches can have different causes, symptoms and triggers, which is why understanding your headaches is an important first step toward finding relief. While some headaches may be linked to stress, lack of sleep, dehydration or changes in routine, others may be related to hormonal changes, diet, medications or underlying medical conditions.

Before creating a treatment plan, our headache specialists take the time to understand your symptoms, medical history and overall health. Learning more about your headaches, when they occur and how they affect your daily life helps us identify the type of headache you're experiencing and determine the most appropriate treatment approach.

Medical History and Physical Examination
Your appointment begins with a conversation about your headaches. We'll discuss when your symptoms start, how often headaches occur, where the pain is located, potential triggers and any treatments you've tried in the past. We also recommend keeping a headache diary to help identify patterns and provide additional insight into your symptoms.

Your provider will perform a physical examination and review any factors that may be contributing to your headaches, including sleep habits, medications, stress levels, hydration, nutrition and other health conditions. This information helps us develop a more complete picture of your health and symptoms.

Neurological Evaluation
Headaches can sometimes be linked to conditions involving the brain, nerves or nervous system. During your evaluation, your provider may perform a series of simple neurological assessments to evaluate your vision, balance, coordination, reflexes, muscle strength and other neurological functions.

These evaluations help us better understand your symptoms and determine whether additional testing may be helpful.

Imaging and Diagnostic Testing
While many headaches can be diagnosed through a detailed medical history and neurological examination, some patients may benefit from additional testing. Although not routinely needed, MRI or CT scans may be recommended with certain symptoms or examination findings to rule out other causes of headache. These tests take approximately 30 to 60 minutes and are virtually painless.

If additional testing is needed, your care team will explain the process and help coordinate the next steps in your care.

Keep a Headache Diary
Keeping track of when headaches occur, how long they last, what symptoms accompany them and any possible triggers can help identify patterns and uncover what's causing your headaches. Track:

• The day and time your headaches occur.
• How severe the headache feels on a scale of 1 to 10.
• Foods eaten that same day.
• Sleep habits that week.
• Stress levels during this time frame.
• Medications used during that week. Include any over-the-counter medications and supplements.

Trigger Identification and Education
Triggers for migraine headaches are different for each person. Triggers include changes in daily routine, foods, hormones, medicines, lights, odors or other things in the environment.

The most common migraine triggers are:

• Stress (either during a stressful time or right after stress subsides).
• The menstrual cycle in women and hormonal changes.
• Changes in your routine, such as how much you exercise or how much you sleep.
• Fasting or skipping meals.
• Changes in the weather, heat or high humidity.
• Bright lights, glare, or reflected sunlight.
• Foods such as chocolate, nuts and artificial sweeteners.
• Alcoholic beverages, including beer, wine and spirits.
• Odors such as perfume, paint, dust, candles, scent diffusers and certain flowers.

Other migraine triggers can include:

• Strong emotions, such as depression or anxiety.
• Pushing yourself too hard when you exercise.
• Monosodium glutamate (MSG), which is often found in processed and savory manufactured foods such as canned soups, instant noodles and ramen, flavored potato chips and fast food.
• Nitrates, which are found in cured meats such as hot dogs, bacon, and cold cuts.
• Preservatives.
• Foods that contain tyramine, such as aged cheeses, pickled or marinated foods and foods made with yeast.
• Smoking or being around someone who smokes.
• Excessive caffeine or caffeine withdrawal.
• Birth control pills and hormone therapy.
• Medicines that expand (dilate) the blood vessels (vasodilators), such as nifedipine and nitrates.
• Allergies.
• Excessive noise.

No Two Headaches are Exactly Alike
Headache treatment is not one-size-fits-all. Effective treatment starts with understanding the type of headache you experience, how often symptoms occur, potential triggers and the impact headaches have on your daily life.

Our headache specialists work closely with you to create a personalized treatment plan designed to relieve symptoms, reduce headache frequency and help you get back to doing the things you enjoy.

Medication Management
Many patients benefit from medications that help prevent headaches before they start or reduce symptoms once a headache begins.

Your provider may recommend:

• Preventive medications to reduce headache frequency and severity.
• Acute treatment medications to help stop a headache once it begins.
• Newer migraine-specific therapies when appropriate.

We will work with you to find the safest and most effective treatment approach for your symptoms and goals.

BOTOX® for Chronic Migraine
For patients who experience chronic migraines, botulinum toxin (BOTOX®) injections are FDA-approved for migraine prevention in people who meet certain criteria.

BOTOX® works by interrupting pain-signaling pathways involved in migraine attacks and may help reduce the number of headache days experienced each month. This FDA-approved treatment can be especially helpful for people who have not found relief with other preventive medications.

CGRP Therapies
CGRP-targeting medications have become a game-changing treatment option for many people living with migraines. These therapies work by blocking the activity of calcitonin gene-related peptide (CGRP), a protein involved in migraine attacks. Depending on the medication prescribed, treatment may be available as a monthly or quarterly injection or an oral medication.

Lifestyle Recommendations
Lifestyle recommendations focus on factors such as sleep, hydration, nutrition, stress management and physical activity.

Abortive Headache Treatment
Not every headache treatment is designed to prevent headaches from happening. Some treatments are intended to stop a headache after it begins or reduce its severity before symptoms worsen.

In addition to prescription medications, some patients may benefit from therapies designed to provide relief during an active headache. These treatments can include nerve blocks, which use numbing medication to help interrupt pain signals, IV infusion therapies and oxygen therapies for certain headache disorders such as cluster headaches, which can stop cluster headaches within 15 minutes of onset.

Depending on the type of headache you're experiencing, your provider may recommend medications that can help relieve symptoms during an active headache or migraine attack. Our specialists work with you to determine the most effective treatment approach based on your symptoms, headache frequency and overall health.